Current Concepts In Cancer

Abstract

To the Editor:— Dr. Philip Rubin wrote a comment on the effect of delay in treatment on the prognosis of breast cancer ( JAMA 200 :616, 1967) and reviewed the literature which shows that survival after surgery increases with the delay prior to surgery. This phenomenon is particularly striking if survival is dated from the date of tumor detection instead of from the time of surgery, because those patients who have delayed for years have already survived years before they finally come to surgery. As Dr. Rubin indicated, this phenomenon is probably due to natural selection, because the rapidly growing highly malignant cancers do not permit delay while the slowly growing ones of low malignant potential do. As a result, the group with prolonged delay is weighted with favorable cases while the group with short delay is weighted with unfavorable cases. This explanation supports the doctrine that biologic predeterminism is the